![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 27 to 51 of 61. Go back in thread:
Posted by Larry Hoover on May 28, 2003, at 22:25:37
In reply to Lar, Re: Mg? How you making out finding it?, posted by McPac on May 28, 2003, at 20:00:15
> Another poster said that fish oil interferes with magnesium's (and I think other minerals') absorption...what do you think? thanks!
I can't think of a reason for that happening.
Posted by Caleb462 on May 28, 2003, at 22:38:54
In reply to Re: Mg potentiates benzos? Cool! » Larry Hoover, posted by johnj on May 28, 2003, at 11:02:20
> Do you have an opinion on why poop out happens and possible remedies? I don't mean to put you on the spot, but you appear to know more than my doctors who want to give me med after med. Do you believe the possible dopamine depletion thinking that is out there?
>I'll weigh in on the "dopamine depletion" issue. "Depletion" is definitely the WRONG word. This would imply that SSRIs cause the actual amount of dopamine in the brain to decrease, which they don't. What they do, however, is inhibit dopamine release.
This is because of a certain serotonin receptor, called 5-HT2c. 5-HT2c exists in the brain to control the flow of dopamine. 5-HT2c receptors are located on dopamine-containing neurons, and when these receptors are activated by serotonin, the neuron will be inhibited from releasing dopamine. When one takes SSRIs, a greater than normal activation of 5-HT2c receptors occurs, and thus a greater than normal inhibition of dopamine release. Problems such as sexual dysfunction, apathy, etc. stem from this.
Posted by johnj on May 29, 2003, at 8:26:19
In reply to Re: Mg potentiates benzos? Cool!, posted by Caleb462 on May 28, 2003, at 22:38:54
Hi Larry
I wonder if TMG or Enada could be used for this? Any ideas? I don't take an ssri, but remeron does have a sexual side effect for me. But, I can live with that for the time being. I am just curious. Thanks
Johnj
Posted by colin wallace on May 29, 2003, at 9:18:46
In reply to Is their a solution to this? Larry H ?? » Caleb462, posted by johnj on May 29, 2003, at 8:26:19
> Hi Larry
>
> I wonder if TMG or Enada could be used for this? Any ideas? I don't take an ssri, but remeron does have a sexual side effect for me. But, I can live with that for the time being. I am just curious. Thanks
>
> JohnjJohnny Boy,
Sorry to hear about your floppiness :)
On a similar theme, I've just started taking5mg NADH on alternate days, to supplement the 20mg Prozac I also take on alternate days.(along with my 250mg Lamictal).
Feels good so far- oddly, it tended to stupefy me before I began Prozac, but now (months later) it feels a lot smoother and more subtle.My seratonin levels must have been pitiably low prior to Prozac, now things feel much more in synch.
I definitely believe NADH to be capable of fending off SSRI apathy (to some extent at least),although sorting out sexual side effects would be too good to be true....but who knows???Col.
>
Posted by Larry Hoover on May 29, 2003, at 9:29:03
In reply to Is their a solution to this? Larry H ?? » Caleb462, posted by johnj on May 29, 2003, at 8:26:19
> Hi Larry
>
> I wonder if TMG or Enada could be used for this? Any ideas? I don't take an ssri, but remeron does have a sexual side effect for me. But, I can live with that for the time being. I am just curious. Thanks
>
> JohnjI quit using Remeron for just that reason, John. Sorry, I don't know of a remedy.
Lar
Posted by johnj on May 29, 2003, at 11:04:38
In reply to Re: Is their a solution to this? Larry H ?? » johnj, posted by Larry Hoover on May 29, 2003, at 9:29:03
I am wondering if the dysfunction would be better if I dropped the TCA? Just have to try and see I guess. However, at this point in time I might have to live with the dysfunction. Last time I went off remeron I had to bump my benzo up due to anxiety/sleeplessness.
I am told the sleeplessness is a symptom of depression/anxiety. I would hate to have to drop the remeron and bump up my benzo. Until now things were always set off by something environmental, but this the last year or so the only thing really bothering me is work stress. Confustion reigns right now. Too bad cymbalta is not out yet as I would like to give it a try.Larry what is your take on benzo's? I am on tranzene but I would like to see if maybe konopin is better for me. I am a little scared to try it. Have you ever tried buspar? Maybe I should wait for xanax XR. Do you have any opinions about benzo's contributing to depression?
The empowering you discussed makes me realize I need to find my way to help myself.
Thank you. take care
johnj
Posted by Larry Hoover on May 29, 2003, at 12:00:04
In reply to Re: Is their a solution to this? Larry H ?? » Larry Hoover, posted by johnj on May 29, 2003, at 11:04:38
> Larry what is your take on benzo's?I use temazepam every night. I have major insomnia, but that's one of the core symptoms of chronic fatigue syndrome.
>I am on tranzene but I would like to see if maybe konopin is better for me. I am a little scared to try it.
Clonazepam has mood stabilizing effects not found in other benzos. I'd have to look up the details. I've wanted to try it, but my p-doc just won't give it to me. Don't know why.
>Have you ever tried buspar?
Nope.
>Maybe I should wait for xanax XR. Do you have any opinions about benzo's contributing to depression?
Only in so far as I don't think they treat the underlying pathology, as I was saying yesterday. I don't think they're destructive. They're just the quintessential example of symptom management.
> The empowering you discussed makes me realize I need to find my way to help myself.
> Thank you. take care
> johnjSometimes you don't even realize the choices you've got, ya know? And just coming to the understanding that you do have choices is more than half the battle. When you get there, you're already "over the hump".
Some aphorisms that have helped me....
"Yesterday is history. Tomorrow's a mystery. Today is a gift. That's why they call it the present."
"You can't think your way into a new way of acting, but you can act your way into a new way of thinking."
....which has a corrollary in, "If you keep on doing what you always did, you'll keep on getting what you always got."
....and another one in, "Doing the same thing over and over again, and expecting different results, is a true measure of insanity."
....which underlie my belief that you have to "do the experiment".
I'm glad you like what I have to say. Thanks for letting me know that.
Lar
Posted by samplemethod on May 29, 2003, at 12:57:45
In reply to Re: Is their a solution to this? Larry H ?? » johnj, posted by Larry Hoover on May 29, 2003, at 12:00:04
Even though I'm new, I value your contributions to this board a great deal.
Thanks Lar
>
> > Larry what is your take on benzo's?
>
> I use temazepam every night. I have major insomnia, but that's one of the core symptoms of chronic fatigue syndrome.
>
> >I am on tranzene but I would like to see if maybe konopin is better for me. I am a little scared to try it.
>
> Clonazepam has mood stabilizing effects not found in other benzos. I'd have to look up the details. I've wanted to try it, but my p-doc just won't give it to me. Don't know why.
>
> >Have you ever tried buspar?
>
> Nope.
>
> >Maybe I should wait for xanax XR. Do you have any opinions about benzo's contributing to depression?
>
> Only in so far as I don't think they treat the underlying pathology, as I was saying yesterday. I don't think they're destructive. They're just the quintessential example of symptom management.
>
> > The empowering you discussed makes me realize I need to find my way to help myself.
> > Thank you. take care
> > johnj
>
> Sometimes you don't even realize the choices you've got, ya know? And just coming to the understanding that you do have choices is more than half the battle. When you get there, you're already "over the hump".
>
> Some aphorisms that have helped me....
>
> "Yesterday is history. Tomorrow's a mystery. Today is a gift. That's why they call it the present."
>
> "You can't think your way into a new way of acting, but you can act your way into a new way of thinking."
>
> ....which has a corrollary in, "If you keep on doing what you always did, you'll keep on getting what you always got."
>
> ....and another one in, "Doing the same thing over and over again, and expecting different results, is a true measure of insanity."
>
> ....which underlie my belief that you have to "do the experiment".
>
> I'm glad you like what I have to say. Thanks for letting me know that.
>
> Lar
>
Posted by McPac on May 29, 2003, at 18:33:18
In reply to Re: Is their a solution to this? Larry H ?? » johnj, posted by Larry Hoover on May 29, 2003, at 9:29:03
" I don't take an ssri, but remeron does have a sexual side effect for me."
>>>>>>> Remeron doesn't cause sexual side efects for most people, correct? I've read that sometimes it is actually prescribed to help improve SSRI-induced "floppiness", lol,......I'm taking it and so far it seems to help.....does that mean it has 'anti-droop' characteristics for me, lol.
Posted by Caleb462 on May 29, 2003, at 18:53:51
In reply to john/Larry, Re: Is their a solution to this? , posted by McPac on May 29, 2003, at 18:33:18
> " I don't take an ssri, but remeron does have a sexual side effect for me."
>
> >>>>>>> Remeron doesn't cause sexual side efects for most people, correct? I've read that sometimes it is actually prescribed to help improve SSRI-induced "floppiness", lol,......I'm taking it and so far it seems to help.....does that mean it has 'anti-droop' characteristics for me, lol.This is true, Remeron usually lacks sexual side effects, and for some folks (like my girlfriend) reverses SSRI-induced sexual side effects. So apparently, john, their is something else going on other than 5-HT2c activation. I would think NADH could help with this. And of course there are plenty of prescription meds that would likely help.... ritalin, mirapex, viagra, dexedrine, requip, etc.
Posted by mattdds on May 29, 2003, at 20:10:49
In reply to Re: Is their a solution to this? Larry H ?? » johnj, posted by Larry Hoover on May 29, 2003, at 12:00:04
Larry,
All this (your post) sounds very CBT'ish. I am curious as to your take on CBT. Do you have any formal CBT-type therapy under your belt? Or do you use CBT self help techniques? Or not a "believer"? It often seems your posts have embedded CBT suggestions in them, haha. I enjoy reading them.
I myself am a big enthusiast of CBT, and think it is the most underutilized tool in psychiatry. It relieved about 80% of my generalized anxiety, 100% of my depression and 100% of anticipatory anxiety secondary to panic attack symptoms.
Klonopin helps with residual derealization that I can't seem to shake, and I am currently experiencing what I feel is a good response to Mg supplementation (seems to help with MVP-like symptoms that overlap a lot with panic, e.g. palpitations, random sympathetic discharge, insomnia. It also seems to "smooth" out my moods, like a mild mood stabilizer. I'm also pretty sure it augments my Klonopin. Recently, I've reduced my dose a bit, as my old dose is making me sedated! Time will tell. As for now, I'm getting more and more convinced.)
But I digress, my question was about CBT. What's your take?
Thanks,
Matt
"Yesterday is history. Tomorrow's a mystery. Today is a gift. That's why they call it the present."
"You can't think your way into a new way of acting, but you can act your way into a new way of thinking."
....which has a corrollary in, "If you keep on doing what you always did, you'll keep on getting what you always got."
....and another one in, "Doing the same thing over and over again, and expecting different results, is a true measure of insanity."
....which underlie my belief that you have to "do the experiment".
Posted by colin wallace on May 30, 2003, at 3:56:13
In reply to john/Larry, Re: Is their a solution to this? , posted by McPac on May 29, 2003, at 18:33:18
> " I don't take an ssri, but remeron does have a sexual side effect for me."
>
> >>>>>>> Remeron doesn't cause sexual side efects for most people, correct? I've read that sometimes it is actually prescribed to help improve SSRI-induced "floppiness", lol,......I'm taking it and so far it seems to help.....does that mean it has 'anti-droop' characteristics for me, lol.When I was taking Remeron, my gut grew so fat I couldn't even reach my pecker if I wanted to...
Posted by Ron Hill on May 30, 2003, at 10:55:09
In reply to Re: john/Larry, Re: Is their a solution to this? » McPac, posted by colin wallace on May 30, 2003, at 3:56:13
> When I was taking Remeron, my gut grew so fat I couldn't even reach my pecker if I wanted to...
Or did you just sit to pee when you were on Remeron? :-)
-- Ron
Posted by JackT on May 30, 2003, at 11:25:15
In reply to Re: Mg? How you making out finding it? » JackT, posted by Larry Hoover on May 28, 2003, at 15:04:24
Lar,
I haven't had a chance to go to Wal-Mart yet. I'll try there first this week-end and then the on-line store you recommended.
I've got another question for you. What is your take on d-phenylalanine as a precursor to phenylethylamine? Do you suspect it would work as a mild anti-depressant?
I have been looking for something that would make me feel good again. Between the GAD, social phobia, and the benzos, I just don't enjoy life. I go through the motions everyday but I'm always mildly depressed (nothing clinical). I've been considering Nardil, mainly because of Ace, selegiline (although my current pdoc won't prescribe it) and mirapax (sp?). Do you have any guidance of drugs or supplements with a lasting dopamine boost or other mood-lifting mechanisms? I'm willing to try almost anything if it looks promising. Maybe this is an impossible question to answer and I probably have asked it before. Anyway, it doesn't hurt to keep probing.
Jack T.
Posted by colin wallace on May 30, 2003, at 11:52:25
In reply to Re: It must have been hard to use the urinal, huh? » colin wallace, posted by Ron Hill on May 30, 2003, at 10:55:09
Posted by Squiggles on May 30, 2003, at 11:56:30
In reply to I used incontinence pants (?!!!) (nm) » Ron Hill, posted by colin wallace on May 30, 2003, at 11:52:25
I wonder if this is considered uncivil?
Hmmm.
Squiggles
Posted by colin wallace on May 30, 2003, at 12:13:55
In reply to Re: I used incontinence pants (?!!!) » colin wallace, posted by Squiggles on May 30, 2003, at 11:56:30
> I wonder if this is considered uncivil?
>
> Hmmm.
>
> SquigglesSorry,
Maybe not uncivil, but granted, a little tasteless.Apologies, kisses, hugs and much grovelling..
Col*****
Posted by Ron Hill on May 30, 2003, at 14:03:53
In reply to Re: Mg? How you making out finding it? » Larry Hoover, posted by JackT on May 30, 2003, at 11:25:15
Hi Jack,
> Do you have any guidance of drugs or supplements with a lasting dopamine boost or other mood-lifting mechanisms?
May I jump in? Larry can tell you better than I, but have you looked into Enada NADH? It works well for me except it can cause irritability. I was able to solve the irritability problem by adding 250 mg/day of TMG and 250 mg/day of niacin.
When I first started taking Enada NADH 18 weeks ago, I took 10 mg/day of the sublingual product ENADAlert NADH during the acute treatment phase for my atypical bipolar depression. The results were immediately remarkable. However, within a week or so the 10 mg/day dose was too much and, therefore, I began titrating the dose in the downward direction. I currently take 2.5 mg twice a week of the enteric coated "down-the-hatch" Enada NADH tablets as a maintenance dose. If you want more detail, just ask.
Here are some of the links discussing Enada NADH:
http://www.healthwell.com/hnbreakthroughs/mar98/nadh.cfm?path=hw
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=8101444&form=6&db=m&Dopt=b
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=9247090&form=6&db=m&Dopt=b
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=9013405&form=6&db=m&Dopt=b
http://www.wholehealthmd.com/refshelf/substances_view/1,1525,10047,00.html#Cautions
http://www.nadh.com/site7/SYSact20.htm#Top
http://www.nadh.com/site7/RSdprs05.htm#Top
http://www.smart-drugs.com/article-JamesSouth-NADH.htm
http://www.nadh-priceinfo.org/
http://qualitycounts.com/fpnadh.html
http://www.immunesupport.com/library/showarticle.cfm/id/3118/T/Both/
http://www.immunesupport.com/library/powersearch2.cfm (Note: enter “NADH” as keyword)
Posted by Larry Hoover on May 30, 2003, at 16:51:04
In reply to Re: Mg? How you making out finding it? » Larry Hoover, posted by JackT on May 30, 2003, at 11:25:15
> Lar,
>
> I haven't had a chance to go to Wal-Mart yet. I'll try there first this week-end and then the on-line store you recommended.
>
> I've got another question for you. What is your take on d-phenylalanine as a precursor to phenylethylamine? Do you suspect it would work as a mild anti-depressant?What I like about it is it's something in your control. It's effect may be subtle, perhaps more noticeable. But you're using your body's machinery the way it was intended to be used, ya know?
L-phenylalanine can get streamed two way....towards PEA, or towards dopamine. D-phenylalanine can only go to PEA. Moreover, it suppresses diversion of L-PA from going towards PEA. So, I generally recommend DLPA, the racemic mixture of d-,l-phenylalanine. Can't hurt. Might help. Take on an empty stomach. Some time that day, make sure you get some B-complex, to make sure the old enzymes are all fired up.
> I have been looking for something that would make me feel good again. Between the GAD, social phobia, and the benzos, I just don't enjoy life. I go through the motions everyday but I'm always mildly depressed (nothing clinical). I've been considering Nardil, mainly because of Ace, selegiline (although my current pdoc won't prescribe it) and mirapax (sp?). Do you have any guidance of drugs or supplements with a lasting dopamine boost or other mood-lifting mechanisms? I'm willing to try almost anything if it looks promising. Maybe this is an impossible question to answer and I probably have asked it before. Anyway, it doesn't hurt to keep probing.
>
> Jack T.There are lots of ideas. Ron mentioned NADH. It directly contributes to dopamine activity. Niacinamide can be soothing (anxiolytic), and also contributes to NADH downstream. Magnesium should have a calming effect, but as many people have noted, there are substantial differences in dose-response. Moreover, magnesium can potentiate (make it seem like you took a higher dose of) your benzos. Be a little cautious. Selenium has been shown to increase measures of well-being even in "normal" people, but also in depressed ones. Fish oil has a general mellowing/resiliency effect for a lot of people. Vitamin C gives some people mental clarity, and we're just getting reports of the same thing from vitamin E. Alphalipoic acid is another antioxidant with psychotropic activity.
There are many things you can try, but just take it slow. You didn't get sick in one day, so it's best to patiently try things, see how they fit in (or not). Go off something, try it again later, to see if the effect is the same. We're talking lifestyle changes here.
Lar
Posted by Larry Hoover on May 30, 2003, at 17:22:42
In reply to Larry, your take on CBT? » Larry Hoover, posted by mattdds on May 29, 2003, at 20:10:49
> Larry,
>
> All this (your post) sounds very CBT'ish. I am curious as to your take on CBT. Do you have any formal CBT-type therapy under your belt? Or do you use CBT self help techniques? Or not a "believer"? It often seems your posts have embedded CBT suggestions in them, haha. I enjoy reading them.I'm glad somebody does. I hate to sound like I'm preaching. Without any feedback, it's awfully hard to "read the audience".
Yes, my posts often contain CBT-based ideas. I can't believe that HMOs, for example, will pay for drug after drug, but not cover CBT to any great extent (if at all). I think attitude problems underly a large number of medication failures. A pill can't fix stinkin' thinkin'.
I am a true believer in CBT. I have a degree in psych, I take part in CBT therapy (as a patient), and I employ self-taught/borrowed "self-help" CBT almost every thought I have. Seriously.
> I myself am a big enthusiast of CBT, and think it is the most underutilized tool in psychiatry. It relieved about 80% of my generalized anxiety, 100% of my depression and 100% of anticipatory anxiety secondary to panic attack symptoms.
OK, I won't preach to you. This is for the rest of the audience. <wink>
What convinced me that cognition has a powerful effect on therapeutic response flows from my own experience. Some years ago now, although I had been released from hospital, I was still very very depressed. My days, my endless stream of days, went something like this. Sleep for 10-12 hours. Get up, walk down the hall, and lie on the couch all day. Maybe open a can and eat straight from the can. Maybe not. Maybe bathe. Maybe not. Go back to bed.
I called this period my "couch days". I spent so much time on the couch (really a futon on a frame), that I had actually created a "Larry-shaped dent" in the damn thing. There it was, that dent, tangible evidence of my inability to function. All I could think about was all the things that needed doing, that weren't getting done. I just couldn't manage to do anything.
Then one day, I had an epiphany. I have no idea where it came from, but it felt heaven-sent. I saw that I had been consuming myself with guilt and self-reproach. I went to the couch for rest, I had assumed, but I got no rest there. I tortured myself, instead.
The day of the epiphany, I saw that Larry-shaped dent in a new way. It was the couch preparing to cradle me. And as I let myself down into that space, I let it hold me. And I emptied my mind of my worries, and let myself rest. And again, the same thing, the next day. I never had another couch day again.
I draw on all kinds of sources. Buddhism has been really helpful. I had a hard time grasping the idea that spiritual growth required adversity, at first. But then I began to see why. If life isn't a struggle, you have no reason to change, to grow.
Here's a contrast of the Buddhist/Western perception. Your house catches fire, and before the firetrucks can arrive at the scene, it burns to the ground. Everybody is safe, but you've lost everything.
Western response? Probably something like: devastated.
Buddhist response: absolute joy.Now, how can the same event inspire such different responses? Cognition.
Here's a symbolic representation. Most people believe that an event triggers an emotional response, a feeling.... i.e. E --> F
But that's not the way it works at all. You interpret the event before you feel.
E + I --> F
Your cognition, which can respond instantaneously when needed, will interpret events, and then trigger emotions consistent with the interpretation. You can't do anything about E. That's reality. You've no control over reality. And feelings arise from cognitive "templates", beliefs, attitudes, assumptions, memories, social norms, all that stuff, so you really can't do much to change them *directly*. The only way at the feelings is through deciding on using new interpretations. The only thing I can change is "I".
It takes effort to become aware of cognition, but once that skill is learned, it's with you forever. I feel very empowered whenever I consciously choose a new cognitive schema.
> Klonopin helps with residual derealization that I can't seem to shake, and I am currently experiencing what I feel is a good response to Mg supplementation (seems to help with MVP-like symptoms that overlap a lot with panic, e.g. palpitations, random sympathetic discharge, insomnia. It also seems to "smooth" out my moods, like a mild mood stabilizer. I'm also pretty sure it augments my Klonopin. Recently, I've reduced my dose a bit, as my old dose is making me sedated! Time will tell. As for now, I'm getting more and more convinced.)
Experiments will do that, whereas reading leaves a tad more doubt.
That's where "You can't think your way into a new way of acting, but you can act your way into a new way of thinking." fist in.
> But I digress, my question was about CBT. What's your take?
>
> Thanks,
>
> Matt
>
> "Yesterday is history. Tomorrow's a mystery. Today is a gift. That's why they call it the present."
>
> "You can't think your way into a new way of acting, but you can act your way into a new way of thinking."
>
> ....which has a corrollary in, "If you keep on doing what you always did, you'll keep on getting what you always got."
>
> ....and another one in, "Doing the same thing over and over again, and expecting different results, is a true measure of insanity."
>
> ....which underlie my belief that you have to "do the experiment".CBT is a wonderful tool.
Lar
Posted by Squiggles on May 30, 2003, at 19:07:59
In reply to Re: Larry, your take on CBT?, posted by Larry Hoover on May 30, 2003, at 17:22:42
You're beginning to frighten me.
How come Dr. Bob is so silent?Squiggles
Posted by Squiggles on May 30, 2003, at 19:30:40
In reply to squiggles » Squiggles, posted by colin wallace on May 30, 2003, at 12:13:55
It don't make no never mind to me;
i've done time at usenet - what i find
peculiar is that Dr. Bob is not offended
at this but was offended and reprimanded
me for my complaint against someone calling
doctors pushers.Of course it's his perogative to call
the shots - but what about the rules.Squiggles
Posted by Larry Hoover on May 30, 2003, at 19:51:01
In reply to Re: Larry, your take on CBT? » Larry Hoover, posted by Squiggles on May 30, 2003, at 19:07:59
> You're beginning to frighten me.
> How come Dr. Bob is so silent?
>
> SquigglesHow am I frightening?
Posted by Squiggles on May 30, 2003, at 19:53:21
In reply to Re: Larry, your take on CBT?, posted by Larry Hoover on May 30, 2003, at 19:51:01
Well, what with the emphasis on nutrition,
magnesium, and Cognitive Behaviour Therapy,
i wonder if you are not infact anti-psychiatric
drug treatment.Squiggles
Posted by mattdds on May 30, 2003, at 21:39:02
In reply to Re: Larry, your take on CBT? » Larry Hoover, posted by Squiggles on May 30, 2003, at 19:53:21
>>Well, what with the emphasis on nutrition,
magnesium, and Cognitive Behaviour Therapy,
i wonder if you are not infact anti-psychiatric
drug treatmentWhoa! What on earth are you talking about?
I will let Larry speak for himself, but since when does recognizing that there are other things that work for mental illness besides drugs mean you are "anti-psychiatry"?
Even the most hardcore pharmacologically oriented pdocs will admit that CBT, sound nutrition and a sound philosophical outlook on life will contribute to wellness. Even the American Psychiatric Association has published studies showing that CBT is equally effective as drugs in many disorders such as panic, anxiety and depression. I am not just making this stuff up, it is quickly becoming the standard of care!
I do CBT, *and* take Klonopin, for example. The two approaches (meds and therapy) are not at all mutually exclusive, but are rather extremely synergistic. You see, CBT, meds, and likely supplements are all just different avenues to change the way you feel.
I too feel that the current mental health system has some serious flaws. HMO's would never pay for terrific, evidence-based treatments like CBT because it would simply cost too much, so it's the assembly line approach. Also I believe that the pharmaceutical companies, with their strongly vested financial interests are exerting way too much influence on how psychiatrists are trained. So we are stuck with getting an extremely impersonal "what are your symptoms" ----> "here take this drug" ---->" now get the hell out so I can pay my overhead" approach.
Does this mean I'm "anti-med"? I guess I am anti-**only med**. But meds have saved my rear in more than one situation. They are one extremely important component of my recovery. But I feel without CBT, my response to the meds would not be anywhere near as robust. For example I tried benzos before CBT for panic disorder, and they did not do much. After CBT, I feel close to 100% better most of the time. For me, they very much had a synergistic effect.
It is not good to hold on to ideas or beliefs too tightly. I am as guilty of this as anyone, but I'm learning. But it seems that some people have an almost religious belief in psychopharmacology as the only method that works. We've really bought into the monoamine hypothesis to the point that we don't consider anything else! I'm all for *anything* reasonably safe that will work. I am not Peter Breggin. I just think that the only meds approach in psychiatry is akin to treating hypertension with only drugs, and ignoring the fact that you are prescribing them to an overtly obese chain-smoking couch potato. This approach does not fly for most good internists, so why do psychiatrists do it? To ignore all these other factors, in my mind is nothing short of negligence.
Best,
Matt
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